House Democrat Hopeful that ACA Fix Can be Passed

'It's hard to believe, but Congress can come together'

WASHINGTON -- At least one Democratic lawmaker is optimistic that Congress can pass legislation to help shore up the Affordable Care Act (ACA).

"It's hard to believe, but Congress can come together," Rep. Kyrsten Sinema (D-Ariz.) said here Monday at the annual policy meeting of the Federation of American Hospitals, a trade group for for-profit hospitals. "I'm part of a group [in the House] called the Problem Solvers ... and all we do is work together to find lasting solutions to country's challenges. One area we've been working on diligently for the last year is the stabilization of the [ACA's insurance] market."

The bill that the caucus is developing would fund the cost-sharing reduction (CSR) payments that the federal government sends to insurers on the ACA's healthcare marketplace to help low-income enrollees pay their out-of-pocket costs. The Obama administration had been making the payments, but the Trump administration cut them off.

In addition to funding the CSR payments, the bill "creates patient and state stability funds that can be used for reinsurance," Sinema said. "It [also] leaves the current Medicaid system in place, which has been hugely important to Arizonans' ability to have access to care."

The caucus is hoping that the bill will be included in the omnibus budget legislation expected to be introduced on March 23rd, "so, fingers crossed," she added.

Audience members also heard from Sen. Tim Kaine (D-Va.), who said he was part of a group of senators discussing a similar bill which "involves [first] making sure the federal government makes good on its cost-sharing promise and second, making sure states have the ability to tailor programs in a way that most fits their population," he said. "And third, reinstating the reinsurance provision that was part of the ACA for the first several years. Reinsurance really works to provide stability and bring down premiums for average folks. That's why we use reinsurance in crop insurance -- it's a time-tested strategy that brings costs down."

Kaine, like Sinema, said that CSRs and reinsurance "are very much [talked about] as part of the omnibus bill." He also decried the current debate in Congress about repealing the ACA -- a debate that he pointed out has been going on for 7 or 8 years -- and said that Congress instead needs to "talk about the next steps forward ... I want to be in a position... where we're not afraid to talk about big ideas."

Kaine listed three big ideas he thought Congress should be discussing:

Block granting: This is the idea that instead of states receiving a "match" from the federal government for every dollar they spend on federally approved Medicaid expenses, the government would give each state a lump sum of Medicaid money, regardless of how much the state itself spent, and free up the state to run the program as it wished. "Is there a block grant strategy that would work?" Kaine said. "As a [former] governor [and] mayor, I love flexibility, but I'm really concerned about what block grant proposal would do -- but I am not afraid to have that discussion."

Single-payer: This idea, championed most vocally by Sen. Bernie Sanders (I-Vt.) would replace the current public/private health insurance system with an entirely government-financed one. Because more than 100 million Americans get their health insurance through their employer "and 80% of them are generally happy with their plan, I don't think they're going to believe [it]" when supporters say a single-payer plan will be just as good, but it's still worth discussing, Kaine said.

Public option: This concept -- initially discussed before the ACA was passed but left out of the final bill -- would give people buying insurance on the ACA's health insurance exchange the option of a publicly run healthcare plan. A bill that Kaine introduced along with Sen. Michael Bennet (D-Colo.) "would direct [the Centers for Medicare & Medicaid Services] to develop an insurance policy that they would sell to working families on the exchange," Kaine explained. The policy, which Kaine called "Medicare X," would cover all the "essential health benefits" defined under the ACA, and would be sold at a competitive rate. Kaine emphasized that no government funding would be involved because the policy would be financed entirely by enrollee premiums. "We think ... it would give people additional options and bring costs down," he said.

"What I hope we will do is get out of the mode where it's just about ACA repeal and put on the table all the ideas -- block grant, single payer, Medicare X and I'm sure there are other ideas as well ... and we'll hear from all the stakeholders," Kaine said, including doctors, hospitals, and patients. "I don't think [we can] limp along playing defense and fighting off rear-guard repeal actions and do justice to the healthcare needs of our country."

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